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KNOWLEDGE IN PRACTICE
To answer Knowledge in practice
Answers for Knowledge in practice
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The challenge of applying what you
learn to pharmacy practice!
Knowledge in practice is designed
to be difficult and aims to make you
apply information from articles in this
month’s Australian Pharmacist and other
suggested reading to the questions
below, just as you would for a client/
patient. This section is not meant to
be easy. There are no simple clear-cut
answers to the questions. The standard
references listed below may be of use
when answering the questions.
1. Sansom L (ed). Australian Pharmaceutical Formulary
and Handbook, 22nd Ed. Canberra: Pharmaceutical
Society of Australia, 2012.
2. Rossi S (ed). Australian Medicines Handbook.
Adelaide: Australian Medicines Handbook Pty Ltd;
3. National Prescribing Service [online]. At: www.nps.
4. Merck Manual of Diagnosis and Therapy [online].
5. Product information – available from various
sources, e.g. MIMS, APP Guide or online on
6. Royal College of Pathologists of Australasia. RCPA
Manual [online]. At: www.rcpamanual.edu.au
7. Therapeutic Guidelines Series. eTG complete [CD-
ROM]. Melbourne: Therapeutic Guidelines Limited.
Additional reference: TOXNET Drugs and Lactation Database
(LactMed). National Institutes of Health. At: http://toxnet.nlm.nih.
[Smartphone apps are available at: http://toxnet.nlm.nih.gov/help/
Which of the following scenarios
presents the MOST appropriate advice
based on the information in the
a) Amanda, a 25-year-old first-time
mother who is breastfeeding her baby,
has to undergo intestinal surgery
when her baby is two months old.
The prophylactic antibiotic cover
prescribed is a single dose each of
metronidazole 500 mg IV, cephazolin
2 g IV and gentamicin 140 mg IV.
Amanda should be advised to stop
breastfeeding for 48 hours due to the
potential effects of gentamicin on
b) Bernice, a 28-year-old mother of
two asks for some St John’s wort for
her post-natal depression. Her baby
is 4 weeks old and is exclusively
breastfed. Her GP diagnosed the
depression and wanted Bernice to
start an antidepressant. Bernice was
hesitant and negotiated with him
to allow her to try St John’s wort,
because it is natural. You advise
Bernice that St John’s wort is the safest
antidepressant medicine to take while
she is breastfeeding.
c) Cath, a 34-year-old first-time mother
with severe asthma has been
diagnosed with atrial fibrillation,
discovered during the monitoring
undertaken during her caesarean
section. Her daughter is now three
weeks old and is exclusively breastfed.
Cath brings in a prescription for
warfarin (existing therapy: current
dose 4 mg daily) and digoxin 250 mcg
daily (new drug). You are concerned
about Cath taking these two narrow
therapeutic index drugs during
breastfeeding and recommend
that she should either switch to
formula feeding or change digoxin to
amiodarone, which has a better safety
profile in breastfeeding.
d) Deb (27 years old) has a
five-month-old son whom she
is breastfeeding. She brings in a
prescription from her dentist for
7 doxycycline 100 mg tablets (2
immediately, 1 daily until all taken).
She had a tooth avulsion this morning
and the dentist resited and splinted
the tooth. He also wants Deb to use
chlorhexidine 0.2% mouthwash every
8 hours. Deb is allergic to penicillin.
You advise her that she can continue
breastfeeding while using these
Knowledge in practice
Question 1. Advice about
drugs in breastfeeding
Dr Jones, a local GP, calls you to ask about
a mutual patient, Beth Butler. Beth (25
years old) is 15 weeks pregnant. She has a
history of depression and systemic lupus
erythematosus (SLE). Dr Jones says that
Beth’s SLE is in remission and does not
currently require any treatment, and she
is taking sertraline 50 mg daily for her
depression. Dr Jones informs you that
Beth’s blood pressure has been increasing
over the last four weeks and has reached
the point where it requires treatment.
Dr Jones says she wants to prescribe
the treatment with the best evidence
and asks for your advice on the most
appropriate antihypertensive for Beth.
Of the following options, which is
the MOST suitable antihypertensive
treatment to recommend for Beth?
a) Methyldopa 250 mg twice daily.
b) Clonidine 75 mcg four times a day.
c) Labetalol 100 mg twice daily.
d) Prazosin 0.5 mg twice daily.
Question 2. Hypertension
treatment in pregnancy
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